Job Description

Full-time, 40 hours/week. Monday - Friday, Variable shift 8AM - 4:30PM; work hours may include evenings and weekends. Hybrid Akron, OH.

Summary

The Senior Performance Improvement & Quality Assurance (QA) Nurse is responsible for leading quality improvement (QI) initiatives, monitoring clinical performance metrics, and ensuring compliance with quality standards in ACHC. This role focuses on optimizing patient outcomes, reducing care variability, and implementing evidence-based best practices across the ACHC network. The nurse will work closely with providers, care coordinators, data analysts, and leadership to drive quality assurance, enhance population health strategies, and improve pediatric care delivery.

Responsibilities

1. Lead quality assurance (QA) and performance improvement (PI) programs to enhance care delivery within ACHC.
2. Develop and implement clinical quality measures, evidence-based protocols, and best practices to improve pediatric patient outcomes.
3. Conduct root cause analyses (RCA), gap analyses, and Plan-Do-Study-Act (PDSA) cycles to identify and address performance deficiencies.
4. Monitor HEDIS, NCQA, and CMS quality metrics, ensuring compliance with payer and regulatory requirements.
5. Evaluate clinical workflows and documentation to ensure adherence to quality standards, reducing variations in care.
6. Utilize data analytics tools (e.g., Epic, Tableau, Power BI, Excel, SQL) to track key performance indicators (KPIs), quality metrics, and population health trends.
7. Assist in identification of high-risk pediatric patients, gaps in care, and opportunities for intervention using claims data and electronic health record (EHR) insights.
8. Generate quality improvement reports and dashboards, presenting findings to clinical teams and leadership.
9. Provide real-time feedback and performance coaching to care teams to improve adherence to quality initiatives.
10. Develop and lead education sessions, workshops, and training programs for ACHC staff on quality improvement methodologies and best practices.
11. Mentor nurses, case managers, and care coordinators in implementing patient-centered, high-quality care strategies.
12. Collaborate with providers, care managers/coordinators, and social workers to enhance care coordination and reduce hospital readmissions.
13. Support the integration of social determinants of health (SDOH) screening tools and interventions into pediatric care plans.
14. Identify and address patient safety concerns, adverse events, and near-misses through structured incident reviews.
15. Ensure ACO compliance with state and federal regulations, payer requirements, and accreditation standards (e.g., Joint Commission, NCQA).
16. Assist in audit preparation, external reporting, and regulatory submissions related to quality performance.
17. Maintain knowledge of Medicaid, managed care, and alternative payment models (APMs) to align quality initiatives with reimbursement structures.

Technical Expertise

1. Expertise in project management, quality improvement methodologies, data analysis, and regulatory compliance.
2. Proficiency in electronic health records (EHRs) and quality analytics tools (e.g., Epic, Tableau, Excel).
3. Strong leadership and project management skills, with the ability to drive change in a clinical setting.
4. Excellent communication and relationship-building skills, with a focus on interdisciplinary collaboration.

Education and Experience

Master of Science in Nursing degree with a current unrestricted license as a Registered Nurse in Ohio is required.

1. Certification in Quality Improvement (CPHQ, Six Sigma, or Lean) strongly preferred.
2. Minimum 5 years of nursing experience in quality assurance, performance improvement, population health, or case management.
3. Experience in pediatric healthcare, managed care, or accountable care organizations (ACOs) highly desirable.
4. Strong knowledge of HEDIS, NCQA, CMS quality programs, and risk-adjustment methodologies.

FTE: 1.000000

Status: Fixed Hybrid

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